[waitman192]

in reply to: review TSH, T3, Free thyroxine #1065560

Hi Shirley,
So for sure the doctors want to treat you the person and symptoms and not the labs. If your TSH is low, but you’re still feeling fine, then there’s no real point in correcting "just" a number. It seems like the synthroid you were on (150) was keeping you at a good state, and the fact that you’re symptoms are returning after you are reducing synthroid tells me that you need your synthroid and that you have no working thyroid gland left. Your TSH almost always lags behind your T4 (I say almost always because there are "almost" never certainties in medicine… get it?? hehe).

As you go down on your synthroid, if your TSH never rises, then there’s reason to go looking at your pituitary, as it should respond to a low level of thyroid hormone in your body. However, generally, you would start to see some other symptoms as well, as the thyroid area of the pituitary does not usually get selectively knocked out (so to speak).

My guess is multifactorial. There can be individual variations, the true statement about thyroid tissue being left over, most especially after a sub-total thyroidectomy, and possibly a slight to moderate resurgence of your Graves Disease. If your eye disease is worsening, it might be worth it to get another antibody level, as the eye disease is unrelated to thyroid hormones themselves, but rather the antibodies that have been created. And to throw in another variable, I do not know your age, however you mentioned you were euthyroid for 35 years, so I could jump to a conclusion that menopause is also playing a role in all that you are feeling as well, especially as thyroid hormone and estrogens/progesterones use similar proteins in the blood to "travel" (the thyroid binding protein and sex-hormone binding proteins are similar enough in structure that they can bind to either especially when either one of them is high enough in the blood.)

I know that was a lot of medicalese… so to simplify it we use a train analogy. You have 2 trains each carrying a different hormone (thyroid and estrogen), and these two trains have found a happy balance in your body. All of the sudden, you have started menopause, which causes a huge increase in estrogen. The estrogen has gotten greedy, and taken over part of the thyroid train, and all of the sudden everything has run amuck in your body. Take that into account with the whole decreasing your synthroid (the synthetic version of thyroid hormone), a possible slight resurgence of Graves (as you have noticed with increased eye disease), and there’s just a lot going on. I could be way off base here, and you went through menopause 20 years ago, and the symptoms are just related to the decreasing of synthroid, but there’s obviously a lot of variation as to what may actually be happening, which is why it’s good you’re going to your doctor on Friday! Ha!

[waitman192]

in reply to: Beta Blockers might interfere with conversion of t3 to t4 #1065968

Man, I had a long response typed out, and it got lost on the computer. Blast. So I’ll try and summarize.
I had a bunch about your thyroid "no longer functioning" but also you’re not hypothryoid, which might not make too much sense (counterintuitive, if you will). My best guess is that the radioactive iodine did what most nuclear medicine people want it to do: knock enough thyroid out to make you go normo-thyroid. So for the most part, your thyroid isn’t working. As for the antibody question, everyone’s a little different. Some people might clear the antibodies a lot quicker than others, and you might just be that person. The good news is, you’ve beat the Graves! It’s really really important to follow up with you doctor though to trend those TSH’s, because they can rise quickly (meaning you’re going hypothyroid.) So just check every 6 months, and you’ll be better off. If you notice yourself slowing down, gaining weight despite eating well, then you might want to get yourself checked out.

Beta blockers. You’re right, there is some potential that they block the T3/T4 conversion process, as the inhibit one of the enzymes in that pathway. But this is minimal. The bigger effect is on the heart and your arteries. When your beta-receptors on your heart and arteries are stimulated, they tell the heart to pump faster, and your arteries to constrict, which results in a higher blood pressure, as the arteries are not as pliable and the heart needs to pump harder to get the blood all the way to your toes. So the beta blocker does what it says, it blocks the beta receptors on your heart and in your arteries, meaning your heart isn’t working as hard which is good, because you don’t want to work really hard for awhile and then poop out before you’re ready for it to die. (Think you can walk for a really long while, but you can only sprint a little bit before tiring out.)

About the dexamethasone, not totally sure, but my guess is that thyroid hormone and dex are similar in shape as they are both steroids (thyroid hormone being a steroid hormone). When you have a lot of dex, it outcompetes the thyroid hormone in thyroid storm, meaning the effects of thyroid hormone are muted. If that’s the way it works (like I said, I’m not sure), when you take dex for headaches, your thyroid symptoms might get better, but I can’t really see it totally effecting your other meds — though I’m not sure what other meds you’re on– you should be off PTU/Methimazole if you had radioactive iodine.

Hope that makes some sort of sense?

[waitman192]

in reply to: Question about Grave’s Eye Disease #1065960

Agreed with everything Ski said. And you can have problems without physical symptoms. For me personally, I don’t have exophthalmus per se, however I do have significant changes in my eyes namely periorbital edema, visual field defects, and double vision in certain areas of my visual fields. It can be a little more serious because I did the radioactive iodine last week and concurrently started a 5 week course of prednisone because of the study ski pointed about the worsening of eye disease after radioactive iodine.

Your endocrinologist can’t actually say you have eye disease, but if they see Graves on at least a semi-regular basis, they should be able to notice something if you have it. But really, they should send you to an ophthamologist. (They are the ones that go to doctor school, optometrists are qualified to check your vision, and not look for other significant eye disease.) If you’re concerned, bring it up to your endocrinologist, and s/he’ll likely refer you out.

[waitman192]

in reply to: Very new one… #1066022

Thanks for the replies. I guess I’ll just keep an eye on it.

So another question. I’m 3 days out from RAI and was wondering if other people had an increase in symptoms right after therapy? Last night I couldn’t fall asleep, and today I couldn’t get cold, I couldn’t stop sweating, my hands couldn’t stop shaking, my eyes were really blurry and my heart was about to beat it’s self silly. I took an extra 40mg of propranolol (which I’m on 60mg twice a day as it is) and that helped minimally, but I couldn’t just calm down all day. And then, my thyroid actually hurt when I coughed or applied any pressure on it. Has anyone else experienced these kind of things? One of my friends said it was psychosomatic… I’m not crazy, right?? :” title=”Question” /> :” title=”Question” /> I’m debating going into my doctor tomorrow to try and get this stuff under control. The last thing I want is to go into a thyroid storm.

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